Single-center RCT of 120 patients (mean age 81, range 70–90) with acute displaced intracapsular femoral neck fractures. Patients were randomized to bipolar hemiarthroplasty or cemented THR via anterolateral approach. Primary endpoint was Harris Hip Score at 4 and 12 months; secondary endpoints included complications, mortality, ADL status, and EQ-5D quality of life.
Most surgeons historically chose bipolar hemiarthroplasty for elderly hip fracture patients specifically because of fear of dislocation with THR — a concern this trial directly addresses.
When your patient is aged 70–90, community-dwelling, independently ambulatory, and cognitively intact (SPMSQ ≥3/10), this trial supports offering primary THR over bipolar hemiarthroplasty. Better function begins as early as 4 months and widens by one year, without any increase in complications, mortality, or transfusion requirement.
The critical technical point: use the anterolateral approach. The 0% dislocation rate in this trial (and the cited 1% rate in the Keating multicentre RCT via lateral approach) versus 13–32% with posterior approaches makes surgical approach the primary modifiable dislocation risk factor.
Reserve hemiarthroplasty for lower-demand patients, those with significant cognitive impairment, or those with higher operative risk. The THR advantage is specific to the well-selected patient described by these inclusion criteria.
Single-center RCT of 120 patients (mean age 81, range 70–90) with acute displaced intracapsular femoral neck fractures. Patients were randomized to bipolar hemiarthroplasty or cemented THR via anterolateral approach. Primary endpoint was Harris Hip Score at 4 and 12 months; secondary endpoints included complications, mortality, ADL status, and EQ-5D quality of life.
Most surgeons historically chose bipolar hemiarthroplasty for elderly hip fracture patients specifically because of fear of dislocation with THR — a concern this trial directly addresses.
When your patient is aged 70–90, community-dwelling, independently ambulatory, and cognitively intact (SPMSQ ≥3/10), this trial supports offering primary THR over bipolar hemiarthroplasty. Better function begins as early as 4 months and widens by one year, without any increase in complications, mortality, or transfusion requirement.
The critical technical point: use the anterolateral approach. The 0% dislocation rate in this trial (and the cited 1% rate in the Keating multicentre RCT via lateral approach) versus 13–32% with posterior approaches makes surgical approach the primary modifiable dislocation risk factor.
Reserve hemiarthroplasty for lower-demand patients, those with significant cognitive impairment, or those with higher operative risk. The THR advantage is specific to the well-selected patient described by these inclusion criteria.